Surgical medical insurance reimbursement process

The reimbursement process of surgical medical insurance is as follows:

1. Go through the admission formalities: you need to show your medical insurance card and ID card when you enter the hospital. The hospital will fill in the medical insurance hospitalization application form and provide hospitalization settlement vouchers;

2. Go through the discharge formalities: When leaving the hospital, you need to bring the hospital settlement voucher, medical insurance card, personal ID card, hospitalization expenses and other related materials to the inpatient department of the hospital to go through the discharge formalities. The hospital will calculate the reimbursement amount according to the proportion of medical insurance reimbursement and print out the hospital hospitalization invoice;

3. Reimbursement application: You can apply for reimbursement to the local medical insurance department with hospital invoices, hospitalization expenses list, hospitalization medical records and other related materials. The medical insurance department shall review the materials provided, and if the materials are approved, the reimbursement amount shall be credited to the bank account.

Medical insurance reimbursement conditions:

1. Confirm the insured status: before seeking medical treatment, you need to confirm that you have participated in local medical insurance, which can be confirmed by means of social security card and medical insurance certificate;

2. Medical category: Medical insurance generally only reimburses therapeutic medical behaviors, such as outpatient service, hospitalization, surgery and examination. Some cosmetic medical behaviors, such as dental beauty and plastic surgery, are usually not covered by medical insurance reimbursement;

3. Medical expenses: Medical insurance will only reimburse medical expenses that meet the requirements, such as medical expenses, medicine expenses, examination expenses, operation expenses, etc. Personal expenses, medical insurance will not be reimbursed;

4. Hospital qualification: Medical insurance will only reimburse the medical expenses of legally operated medical institutions, such as public hospitals and qualified private hospitals. Medical insurance will not be reimbursed for illegal medical institutions or clinics.

To sum up, medical insurance policies and reimbursement standards may be different in different regions. For more detailed information, please consult the local medical insurance department or hospital. When going through the admission and discharge procedures, you must show your medical insurance card and ID card, and keep the relevant materials properly.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.